Management of sleep disturbances in the ICU: a secondary analysis of the ESPRIT study

Sleep disturbances are frequent in the intensive care unit (ICU) and are associated with delirium or delayed mechanical ventilation weaning. Although international guidelines recommend structured screening and non-pharmacological management, their implementation in daily practice is poorly reported. This study aimed to evaluate the prevalence, screening practices, and management strategies for sleep disturbances in French ICUs.

This was a secondary analysis of the ESPRIT study, a national, multicenter, cross-sectional study conducted in 128 ICUs. All adult patients admitted on the study day were eligible. Data on unit-level practices and patient-level disturbances were collected. Sleep disturbances were identified by bedside physician. A multivariable multilevel logistic regression identified factors independently associated with sleep disturbances.

Among 1,361 patients, 445 (33%) were reported to have sleep disturbances. Only 18% of ICUs conducted routine screening, and no center had implemented a multicomponent protocol. Environmental measures such as light and noise reduction were common, whereas earplugs 51/128 (40%) and eye masks 18/128 (14%) were rarely used. Pharmacological treatments were given to 219 patients (16%), mainly Z-drugs and hydroxyzine. In multivariable analysis, overnight family presence (OR 2.06 [1.12-3.81], p = 0.021) and physical restraints (OR 2.26 [1.39-3.70], p = 0.001) were independently associated with increased risk of sleep disturbances. Optimization of nursing tasks was the only intervention that tended to reduce sleep disturbances (OR 0.57 [0.31-1.04], p = 0.069).

Sleep disturbances are common in ICUs, yet routine screening and structured management remain rare. Standardized, nurse-led screening and broader adoption of non-pharmacological protocols are needed to improve sleep quality and patient outcomes.